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Feb 17 12 08:15a Reliable Petrole 45-8953 p.6 <br />SAN JOAQUIN COUNTY a, <br />ENVIRONMEWAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 1Yeh: www.sjeov.org/ehd <br />FACILITY NAME FACILfTY CONTACTNAME <br />FACILITY ADDR SS SITE PHONE #WITH AREA CODE <br />q-5-7 Lc/, LS i, tk 2� `I Z- 2-� Y <br />CITY SATE ZfP GODE # O TANKS AT SITZ <br />CA 952.0 j <br />APPLICANT BILJING <br />NAME <br />APPLICANT CONTACT NAME <br />110-1-116 <br />r©1 er e J r S'�Yv c �-5 N c <br />6 L� -e ScL <br />APPLICANT MAILING ADDRESS <br />w 1-1 2 e <br />APPLICANT PHONE W WITH AREA CODE <br />2009 <br />2010 2011 <br />$ <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE <br />CONTRACTOR ICC # <br />TANK PESESSED <br />Closure Installation e air etrofii <br />250 571 <br />PERMANENTCL SURE <br />Removal or Permitted Closure in Place' • <br />TANK ID # (s): CLOSURE FEE = $3751 TANK # TANKS X S375 = <br />TEMPORARY CLC SURE <br />Plan Review and Inspections) <br />TANK ID # (s) : TEMPORARY CLOSURE FEE = $375 / FACILITY $ <br />and C nstruction Inspections) <br />TANK ID # (ej: <br />PLAN CHECK FEE = $1,000 / FACILITY <br />$ <br />$550 FEES <br />$500 FEEMTANK <br />5125 PERTER <br />S FACILITY FEE + t TANK (2006-2007)) <br />FACILITY FEE + 1 TANK (2008-2011', <br />FIRST TANK <br />2006 <br />2007 <br />2008 <br />2009 <br />2010 2011 <br />$ <br />UNAUTHORIZED RE 7LEASE EVALUATION FEE = $ 125 d HOUR <br />$ <br />SAMPLING INSPECTION FEE = $1251 HOUR <br />ALL FEES ARE 13ASEL, ON THE $125 HOURLY BATF_ T1MF T94AT cve cme <br />$ <br />TANK PESESSED <br />$ <br />TANK SURCHARGE <br />= $151 TANK <br />$ <br />STATE SURCHAR <br />E FOR FACILITIES NOT ALREADY ON INVENTORY INA CUPA PROGRAM =$49.00; FACILITY <br />S <br />PERMANENTCL SURE <br />Removal or Permitted Closure in Place' • <br />TANK ID # (s): CLOSURE FEE = $3751 TANK # TANKS X S375 = <br />TEMPORARY CLC SURE <br />Plan Review and Inspections) <br />TANK ID # (s) : TEMPORARY CLOSURE FEE = $375 / FACILITY $ <br />and C nstruction Inspections) <br />TANK ID # (ej: <br />PLAN CHECK FEE = $1,000 / FACILITY <br />$ <br />REPAIR PLAN CHECK <br />TANK ID # (s) <br />TANK RETROFIT R PAIR FEE = $375 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, $ <br />s ill buckets, sum s, mise. <br />PIPING REPAIR FE _ $375 !FACILITY iuse for pi in ,under-dispenserc�ntainment, ect.} $ 37 `— <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />S <br />CONSULTATION F E _ $1251 HOUR <br />$ <br />UNAUTHORIZED RE 7LEASE EVALUATION FEE = $ 125 d HOUR <br />$ <br />SAMPLING INSPECTION FEE = $1251 HOUR <br />ALL FEES ARE 13ASEL, ON THE $125 HOURLY BATF_ T1MF T94AT cve cme <br />$ <br />TOTAL AMOUNt DUE <br />OFFICE USE ONLY <br />032 <br />9 <br />